CARE MANAGER

Madison General Insurance Kenya Limited, a subsidiary of Madison Group and a leading provider of general insurance products throughout Kenya, is recruiting for the above position.Care Management, handling Outpatient, Optical and Dental preauthorizations, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns and managing the 24-hour emergency line.Care Management – Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise, for declines, ensuring that the decisions are accurate and a correct interpretation of the policyEnsure appropriate Turnaround Time is adhered to in issuing approvals.Seeking medical clarifications including medical reports, copies of investigation reports from providers as per standard procedure.Broker/customer relations by communicating all necessary claim decisions to clients on a timely basis.Work with the claims team and providing on any information required in the claims submitted in cases where further information provided changes the position undertaken previously on the claim.Interacting with clients, brokers and providers as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.Engaging providers on matters cost, discounts, pre-agreed rates, packages, fixed cost and average cost agreements.Ensure accurate information is captured in the system and have a zero-error rate in benefit adjudication of all casesLiaising with underwriting department on scope of cover for various schemesLiaising with provider relations section on matters pertaining to provider panel, customer complaints etcManaging the 24-hour emergency helplineImplementation of strategic initiatives for the department and recommendations by claims QA committee.Achieve an...